Quality parameters for the medicinal plant Drosera rotundifolia L.: A new approach with established techniques

Monographs of the European Pharmacopoeia (Ph. Eur.) are the basis for quality control of medicinal plants and therefore important to ensure the consistency, quality, safety, and efficacy of phytopharmaceuticals. The traditional medicinal plant sundew (Drosera sp.) has disappeared from therapy due to nature conservation, but can now be cultivated sustainably on rewetted peatland. However, currently there is no valid Ph. Eur. monograph for the quality control of Droserae herba. In this study, sundew material from different species and sources was investigated with the aim of developing quality control methods based on the Ph. Eur. and defining a uniform quality standard for Droserae herba. It was possible to distinguish between sundew species of different quality, using macroscopic, microscopic, and chromatographic methods. Special emphasis was laid on the content of flavonoids and naphthoquinones as important quality parameters as their content differed between the sundew species. The differences in content and toxicity result in the recommendation that only round-leaved sundew (Drosera rotundifolia L.) should be used as a medicinal plant for the production of phytopharmaceuticals in the future.

Delphi Plus: A novel methodology for identifying evidence-based data standards for health service decision-making

The underlying tenet of evidence-based decision-making in health services is assessing all the relevant evidence. Using the traditional qualitative and quantitative approaches to identifying evidence may not capture the full spectrum of factors that need to be addressed. A selective mixed-method approach may provide a comprehensive assessment of the relevant knowledge. This paper adds to the methodological literature by outlining a novel sequential, mixed-method, exploratory process for identifying evidence-based data standards that may be used for health service decision-making. The three-phase process, entitled Delphi Plus, engages peer-nominated topic-specific experts to assess all publicly available and practice-based items and, through a series of reviews, reach an evidence-based consensus on standards for decision-making. Each process phase is outlined in-depth and supplemented by practical learnings gained through its implementation. The Delphi Plus methodology provides the first comprehensive process for combining the published and practised data to develop evidence-based data standards. The routine use of Delphi Plus would provide a framework for benchmarking in health services, enabling greater monitoring and evaluation of client outcomes and improving quality care. This manuscript describes the process of implementing Delphi Plus and provides an example of data standards generated from its use, which directly inform the Australian Government's Primary Health Care 10 Year Plan.

Quality standards for the care of people with giant cell arteritis in secondary care

OBJECTIVE

GCA is the commonest primary systemic vasculitis in adults, with significant health economic costs and societal burden. There is wide variation in access to secondary care GCA services, with 34% of hospitals in England not having any formal clinical pathway. Quality standards provide levers for change to improve services.

METHODS

The multidisciplinary steering committee were asked to anonymously put forward up to five aspects of service essential for best practice. Responses were qualitatively analysed to identify common themes, subsequently condensed into domain headings, and ranked in order of importance. Quality standards and metrics for each domain were drafted, requiring a minimum 75% agreement.

RESULTS

13 themes were identified from the initial suggestions. Nine quality standards with auditable metrics were developed from the top 10 themes. Patient Access, glucocorticoid use, pathways, ultrasonography, temporal artery biopsy, PET scan access, rheumatology/ophthalmology expertise, education, multidisciplinary working have all been covered in these quality standards. Access to care is a strand that has run through each of the developed standards. An audit tool was developed as part of this exercise.

CONCLUSION

These are the first consensus auditable quality standards developed by clinicians from rheumatology and ophthalmology, nursing representatives and involvement of a patient charity. We hope that these standards will be adopted by commissioning bodies to provide levers for change from the improvement of patient care of individuals with GCA.

Quality Standard for Rehabilitation of Young Deaf Children Receiving Cochlear Implants

Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project "VOICE"-vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent.

Two Parallel Roads Impacting the Functional Preparedness of Accredited Hospitals: The Indian Healthcare Quality Standards and Disaster Management Act 2005

Background

Quality management of healthcare service providers and disaster preparedness are two important aspects that affect patient safety and the overall outcome of care delivery. Accreditation standards and legal framework for disaster management are intertwined and pave the way for achieving the optimum level of safety in healthcare system.

Aims

The aim of the study is to evaluate the functional preparedness of hospital staff for managing disaster situations.

Materials and Methods

It was a quantitative, cross-sectional, ex-post-facto study to understand the functional elements by deeply studying the Knowledge, Attitude and Practice (KAP) scores of various level hospital staff.

Results

Knowledge scores of the participants showed positive correlation with attitude scores (r = 0.424, P < 0.001) and practice scores (r = 0.446, P < 0.001). The study showed a significant difference between mean KAP score of males (14.96 ± 3.5) and female (16.38 ± 2.6). Similarly, the staff who obtained excellent scores in the KAP study belonged to a higher age group while those who obtained poor were in the lowest age group (F (2, 715) =10.739; P < 0.001). The performance of staff significantly increased (P < 0.01) with increase in age as number of years of experience and on-the-job training enriched their understanding. Inspite, of the same level of inputs in terms of training and sensitization inputs, the staff of Administration departments showed higher knowledge than other staff (χ2 =97.37, P < 0.001). Analysis of educational qualification of participants elicits that it has a statistically significant effect on their performance in KAP study (F (5, 709) = 12.82; P < 0.001).

Conclusion

The KAP scores are direct indicator of effectiveness of quality standards in preparing the hospital for disaster management. The study shows that variables like age, gender, department, educational qualification are correlated with performance and affect the attitude and practice during a disaster event.

Exploring quality standards implementation at a South African municipality's health facilities

BACKGROUND

 Despite government initiatives to ensure the delivery of safe and high-quality care in health establishments, most health establishments in the City of Tshwane Metropolitan Municipality, South Africa were non-compliant with the National Core Standards. This study explored the experiences of quality assurance managers regarding quality standards implementation in these establishments.

OBJECTIVES

 This study aimed to explore and describe factors affecting the implementation of quality standards at public health facilities based on quality assurance managers' lived experiences in the research setting.

METHOD

 This qualitative study used phenomenological design by conducting individual in-depth interviews with nine purposively selected quality assurance managers in 2021. The collected data were analysed using Colaizzi's phenomenological analysis framework.

RESULTS

 The study's findings revealed that the legislative framework and the policy environment were motivators for quality standard compliance among the participants. Furthermore, human resources, materials-related issues and poor infrastructure were found to be barriers to the implementation of quality standards in health facilities.

CONCLUSION

 The explored and described barriers must be addressed to improve compliance with the National Core Standards at public health facilities in the City of Tshwane Metropolitan Municipality. In addition, capacity-building for quality assurance managers should be ongoing to ensure the highest quality implementation standards and to strengthen the enforcement of quality standard regulations.Contribution: The study's findings explored and described the factors that influence the implementation of quality standards. Addressing these factors could improve the quality of healthcare delivery in the research setting's health facilities.

Hospital accreditation: an umbrella review

Hospital accreditation is an established quality improvement intervention. Despite a growing body of research, the evidence of effect remains contested. This umbrella review synthesizes reviews that examine the impacts of hospital accreditation with regard to health-care quality, highlighting research trends and knowledge gaps. Terms specific to the population: 'hospital' and the intervention: 'accreditation' were used to search seven databases: CINAHL (via EBSCOhost), Embase, Medline (via EBSCOhost), PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute (JBI) EBP Database (via Ovid). 2545 references were exported to endnote. After completing a systematic screening process and chain-referencing, 33 reviews were included. Following quality assessment and data extraction, key findings were thematically grouped into the seven health-care quality dimensions. Hospital accreditation has a range of associations with health system and organizational outcomes. Effectiveness, efficiency, patient-centredness, and safety were the most researched quality dimensions. Access, equity, and timeliness were examined in only three reviews. Barriers to robust original studies were reported to have impeded conclusive evidence. The body of research was largely atheoretical, incapable of precisely explaining how or why hospital accreditation may actually influence quality improvement. The impact of hospital accreditation remains poorly understood. Future research should control for all possible variables. Research and accreditation program development should integrate concepts of implementation and behavioural science to investigate the mechanisms through which hospital accreditation may enable quality improvement.

Enabling national improvement in quality of care for renal colic

OBJECTIVES

To report the results of a clinical audit conducted by the British Association of Urological Surgeons (BAUS) of ureteric stone care pathways, with results reported with reference to national quality standards.

PATIENTS AND METHODS

The BAUS conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31 March 2021 and the inpatient and outpatient management received was recorded.

RESULTS

Data for 2192 patients across 117 units were submitted. The median (interquartile range [IQR]) number of patients per unit was 16 (9-27); 70% of patients were male and the median (IQR) patient age was 46 (34-59) years. Initial management was conservative treatment for 70% of patients. Overall, primary shockwave lithotripsy was performed in 34% of patients and primary ureteroscopy in 23% of cases when surgical intervention was required to treat the stone. However, 40% of patients in whom active intervention was appropriate underwent placement of a temporizing ureteric stent rather than undergo definitive surgical intervention at the outset. Female patients were less likely to have a computed tomography (CT) scan of the kidneys, ureters and bladder performed within 24 h of presentation (13% vs 7.3% for men [chi-squared P = 0.01]) and to be given correct analgesia (66% vs 73% for men [chi-squared P = 0.03]). Patients aged 60 years or older were also significantly less likely to be offered nonsteroidal anti-inflammatory drug analgesia appropriately. In total, 87% of patients had their calcium measured within the last 2 years and 73% of patients had evidence of being offered stone prevention diet and fluid advice.

CONCLUSIONS

The audit demonstrates that the National Institute of Health and Care Excellence Quality Standards are both measurable and achievable. However, there was considerable variation in the delivery of these standards, including with regard to sex and age, highlighting inequalities for patient care across the UK.

[Development history and prospect of Fel Ursi]

Fel Ursi(bear bile) has been used as medicine for a long history, with wide clinical applications and definite curative efficacy. Fel Ursi has good pharmacodynamic activities in the treatment of liver and gallbladder diseases, and cardiovascular and cerebrovascular diseases. According to the places of origin, traditional Fel Ursi is divided into &quot;Dongdan&quot; and &quot;Nandan&quot;. According to the gallbladder properties, it is divided into &quot;Jindan&quot; &quot;Tiedan&quot; &quot;Caihuadan&quot;, and &quot;Youdan&quot;. With the development of bear bile drainage technology, Pulvis Fellis Ursi has entered the market and been used clinically instead of Fel Ursi. At present, obtaining artificial Pulvis Fellis Ursi by chemical compounding and biotransformation is the hotspot in medical research, which can solve the shortage problem of bear bile resources, and also protect endangered animals. The quality problem of Fel Ursi in the market is prominent, with counterfeit products prepared from sheep bile, cow bile, pig bile, and chicken bile. Due to the scarcity of bear bile resources, the related research contents are scattered, and there is a lack of systematic analysis and summary. This paper focused on the development of Fel Ursi to clarify the source and classification of traditional Fel Ursi, and summarized the harvesting, processing, identification, and use of Fel Ursi. Additionally, the paper also compared the quality standards of Fel Ursi, summarized the technological development process of Pulvis Fellis Ursi, and prospected the modern research and clinical application of Pulvis Fellis Ursi, which is expected to provided references for the collation of bear bile resources, the clinical application of Fel Ursi, the development of Fel Ursi drugs, and related research on artificial Pulvis Fellis Ursi.

Quality Assurance Standards for Outreach Cleft Lip and Cleft Palate Repair Programs in Low-Resource Settings

BACKGROUND

Comprehensive cleft care is a multidisciplinary team endeavor. While untreated craniofacial conditions have multiple undue repercussions, cleft care in outreach settings can be fraught with significant perioperative morbidity risks.

AIM

Propose updated quality assurance standards addressing logistic and operational considerations essential for the delivery of safe and effective cleft lip and /or palate (CL/P) care in low and middle-income countries (LMICs) settings.

METHODS

Based on American Cleft Palate-Craniofacial Association (ACPA) quality standards, published literature, published protocols by Global Smile Foundation (GSF), and the senior author's three-decade experience, updated standards for outreach cleft care were synthesized.

RESULTS

Ten axes for safe, effective, and sustainable cleft lip and palate care delivery in underserved settings were generated: 1) site assessment, 2) establishment of community partnerships, 3) team composition and credentialing, 4) team training and mission preparation, 5) implementation of quality assurance guidelines, operative safety checklists, and emergency response protocols, 6) immediate and long-term postoperative care, 7) medical record keeping, 8) outcomes evaluation, 9) education, and 10) capacity building and sustainability. Subsequent analysis further characterized essential components of each of those ten axes to delineate experience derived and evidence-based recommendations.

DISCUSSION

Quality assurance guidelines are essential for the safe delivery of comprehensive cleft care to patients with CL/P in any setting. Properly designed surgical outreach programs relying on honest community partnerships can be effectively used as vehicles for local capacity building and the establishment of sustainable cleft care ecosystems.

Defining Clinical Excellence for Palliative Care Specialists: A Concept Whose Time Has Come

Experts in the field of palliative care in the United States (U.S.) have defined competence, or "good," mainly for programs, trainees, or providers of primary palliative care. Our interprofessional workgroup of palliative care specialists proposes that setting a standard for clinical excellence, or "great," applicable to palliative care specialists of all professions will elevate the field in the U.S. by providing an aspirational target usable for individual assessment and self-assessment, highlighting the common ground between team roles, and promoting a deeper understanding of teamwork, utilization, and productivity. We call for research that utilizes inclusive methods and broad representation of diverse voices to design a vivid, practical, and evidence-based definition of clinical excellence for palliative care specialists.

The Fracture Liaison Service of the Virgen Macarena University Hospital Reduces the Gap in the Management of Osteoporosis, Particularly in Men. It Meets the International Osteoporosis Foundation Quality Standards

OBJECTIVES

To describe the Fracture Liaison Service (FLS), to know the characteristics of the patients attended with emphasis on sex differences, and to know the compliance of International Osteoporosis Foundation (IOF) quality standards.

METHODS

Observational, prospective research. All the consecutive patients that attended in usual clinical practice from May 2018 to October 2019, were over 50 years, and with a fragility fracture (FF), were included.

RESULTS

Our FLS is a type A multidisciplinary unit. We included 410 patients, 80% women. FF recorded in 328 women were: Hip (132, 40%), Clinical Vertebral (81, 25%) and No hip No vertebral (115, 35%). Those in 82 men were: Hip (53, 66%), Clinical Vertebral (20, 24%) and No hip No vertebral (9, 10%), p = 0.0001. Men had more secondary osteoporosis (OP). The most remarkable result was the low percentage of patients with OP receiving treatment and the differences between sex. Forty-nine (16%) women versus nine (7%) men had received it at some point in their lives, p = 0.04. The probability of a man not receiving prior treatment was 2.5 (95%CI 1.01-6.51); p = 0.04, and after the FF was 0.64 (0.38-1.09). Treatment adherence in the first year after the FLS was 96% in both sexes. The completion of IOF quality standards was bad for patient identification and reference time. It was poor for initial OP screening standard and good for the remaining ten indicators.

CONCLUSIONS

the FLS narrowed the gap in diagnosis, treatment, and follow-up of fragility fracture patients, especially men. The FLS meets the IOF quality standards.

[Research progress on chemical constituents and quality control methods of Succus Bambusae]

Through the investigation of a large number of both domestic and overseas literatures and related quality standards, chemical compositions, quality evaluation system and quality control methods of Succus Bambusae were systematic summarized in this study. There were abundant chemical constituents in Succus Bambusae, mainly including volatile ingredients, amino acids, flavonoids, trace elements and vitamins, with high medicinal and edible value. The quality control methods involved traditional morphological identification, spectroscopy, chromatography and other techniques. However, the current quality standards of Succus Bambusae are relatively low, lacking safety indicators, and cannot effectively ensure its quality, seriously affecting the safety and effectiveness of its clinical use. Therefore, it is particularly important to establish a set of highly sensitive and specific quality evaluation system for Succus Bambusae. In this paper, the current research status of the chemical compositions and quality standards of Succus Bambusae were reviewed, with the purpose of providing a basis for further improvement of its quality evaluation system.

[Research progress on chemical constituents and pharmacological effects of Glycyrrhizae Radix et Rhizoma and discussion of Q-markers]

Glycyrrhizae Radix et Rhizoma, a traditional Chinese herbal medicine, mainly contains triterpenoids, flavonoids, polysaccharides, coumarins and volatile oils with many pharmacological activities such as anti-tumor, anti-bacterial, anti-viral, anti-inflammatory, immune regulatory and anti-fibrotic effects. The widespread applications of Glycyrrhizae Radix et Rhizoma in food, medicine and chemical industries make its demand increase gradually. Therefore, the quality guarantee of the medicinal is of great value. Starting from the elaboration of chemical components and pharmacological effects of Glycyrrhizae Radix et Rhizoma and the introduction to the concept of quality marker(Q-marker), this study analyzed the Q-markers of Glycyrrhizae Radix et Rhizoma from the aspects of plant phylogene-tics, chemical component specificity, traditional efficacy, traditional medicinal properties, absorbed components, different processing methods and so on, which provides reference for quality evaluation, development and utilization of Glycyrrhizae Radix et Rhizoma.

Assessing Technical Assistance Needs among Recovery Residence Operators in the United States

Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.

The Comparison of Physicochemical Parameters, Antioxidant Activity and Proteins for the Raw Local Polish Honeys and Imported Honey Blends

Many imported honeys distributed on the Polish market compete with local products mainly by lower price, which can correspond to lower quality and widespread adulteration. The aim of the study was to compare honey samples (11 imported honey blends and 5 local honeys) based on their antioxidant activity (measured by DPPH, FRAP, and total phenolic content), protein profile obtained by native PAGE, soluble protein content, diastase, and acid phosphatase activities identified by zymography. These indicators were correlated with standard quality parameters (water, HMF, pH, free acidity, and electrical conductivity). It was found that raw local Polish honeys show higher antioxidant and enzymatic activity, as well as being more abundant in soluble protein. With the use of principal component analysis (PCA) and stepwise linear discriminant analysis (LDA) protein content and diastase number were found to be significant (p < 0.05) among all tested parameters to differentiate imported honey from raw local honeys.

Implementation of Royal College of Radiologists Consensus Statements and National Institute for Health and Care Excellence Guidance: Breast Radiotherapy Practice in the UK

AIMS

Breast radiotherapy practice, driven by large randomised controls trials, is increasingly being risk adapted to the biology and stage of the cancer. The aim of this audit was to measure current breast radiotherapy practice in the UK against quality standards from the 2016 Royal College of Radiologists (RCR) consensus statements and the 2018 updated National Institute for Health and Care Excellence (NICE) guidelines. These guidelines include new recommendations for partial breast irradiation for women at lower risk of recurrence and internal mammary chain radiotherapy for those at higher risk.

MATERIALS AND METHODS

Radiotherapy departments completed a questionnaire for all patients starting adjuvant radiotherapy for early breast cancer in a 2-week period mid-2019.

RESULTS

Eighty-one per cent of centres returned data on 958 patients, including 18 bilateral cancers. Of 976 breast cancers, 23.9% were treated with mastectomy. The dose fractionation schedule for adjuvant radiotherapy was 40 Gy in 15 fractions in 95.7% of cases. Of the 743 cases treated with breast conservation, 29.9% received an additional tumour bed boost. The boost was given sequentially in 91.9% of cases and with eight different dose fractionation schedules. Of 494 left-sided breast cancer cases, 54% (n = 267) received radiotherapy in deep inspiratory breath hold. All centres except one had a deep inspiratory breath hold technique available. Only 12% of patients who met the RCR criteria for partial breast irradiation received it. Overall, 14.7% and 9.9% of patients meeting the RCR and NICE criteria for internal mammary chain radiotherapy, respectively, received it.

CONCLUSIONS

Despite established consensus statements and NICE guidelines there persists variation in breast radiotherapy practice in the UK. The results of practice-changing trials showing the benefit of cardiac-sparing radiotherapy techniques, partial breast radiotherapy and internal mammary nodal radiotherapy have not been fully implemented. This audit highlights areas for targeted quality improvement and future consensus statements.

Developing services for long COVID: lessons from a study of wounded healers

Persistent symptoms lasting longer than 3 weeks are thought to affect 10-20% of patients following SARS-CoV-2 infection. No formal guidelines exist in the UK for treating patients with long COVID and services are sporadic and variable, although additional funding is promised for their development.In this study, narrative interviews and focus groups are used to explore the lived experience of 43 healthcare professionals with long COVID. These individuals see the healthcare system from both professional and patient perspectives, thus represent an important wealth of expertise to inform service design.We present a set of co-designed quality standards, highlighting equity and ease of access, minimal patient care burden, clinical responsibility, a multidisciplinary and evidence-based approach, and patient involvement; and we apply these to propose a potential care pathway model that could be adapted and translated to improve care of patients long COVID.

[The abolition of the expertise procedure for outpatient psychotherapy - A reduction of quality in the psychotherapy?]

The abolition of the expertise procedure for outpatient psychotherapy - A reduction of quality in the psychotherapy? Abstract. Objectives: This article investigates whether or not the abolishment of the expertise procedure for an outpatient psychotherapy is a reliable quality feature; and whether or not the elimination of this procedure results in a reduction of quality in outpatient psychotherapy. Methods: We conducted a literature research that considered articles written between the years 2000 and 2020 dealing with the expertise procedure as a quality standard of outpatient psychotherapy. In order to discuss the different views of the cited authors, we also refer to further literature. Results: The expertise procedure is not a reliable quality feature of outpatient psychotherapy. The idea that abolishing the expertise procedure results in a reduction of quality in outpatient psychotherapy is not confirmed by the studies summarized.

Quality of Care Standards in Inflammatory Bowel Diseases: a European Crohn's and Colitis Organisation [ECCO] Position Paper

The management of inflammatory bowel disease [IBD] is complex, and requires tight control of disease activity, close monitoring to avoid treatment side effects, health care professionals with expertise in IBD, and an interdisciplinary, holistic approach. Despite various efforts to standardise structures, processes, and outcomes,1-8 and due to the high variability at the local, national, and international levels, there are still no clear definitions or outcome measures available to establish quality of care standards for IBD patients which are applicable in all contexts and all countries. For this reason, the European Crohn's and Colitis Organisation [ECCO] supported the construction of a list of criteria summarising current standards of care in IBD. The list comprises 111 quality standard points grouped into three main domains [structure n = 31, process n = 42, outcomes n = 38] and is based on scientific evidence, interdisciplinary expert consensus, and patient-oriented perspectives. The list of proposed criteria is intended to represent the position of ECCO regarding the optimum quality of care that should be available to patients. Since health care systems and regulations vary considerably between countries, this list may require adaptation at local and national levels. It is recognised that not all these criteria that have been identified as optimal will be available in every unit. However, ECCO will continue its efforts to develop and coordinate projects and initiatives that will help to guarantee optimal quality of care for all IBD patients.

Curriculum Viability Indicators: A Delphi Study to Determine Standards and Inhibitors of a Curriculum

Curriculum evaluation is typically done by using quality standards defined by accrediting bodies. This does not include inhibitors that hinder the achievement of standards. Hence, to address both standards and inhibitors, we have coined the new concept of "curriculum viability." This study establishes consensus among experts on curriculum viability indicators, i.e. standards and inhibitors, and aims to provide a framework for evaluating the curriculum viability. The study was done in two phases. In the first phase, a consensus was established on the curriculum viability indicators using the Modified Delphi Technique using two rounds. In the first round of the Delphi process, 25 experts participated, which were reduced to 19 in the second round. After two rounds, experts developed a consensus on 40 out of 44 items. These included 27 standards and 13 inhibitors. In the second phase, 18 experts rank-ordered the indicators according to their relative importance in the areas of educational content and strategies, faculty, leadership, assessment, students, educational/working environment, communication, and technology. The list of indicators provides a framework for evaluating the curriculum viability, and their ordering enables curriculum managers to prioritize them during curriculum evaluation.

[Recommendations on quality standards of Alismatis Rhizoma in Chinese Pharmacopoeia(2020 edition)]

The present research was launched to improve the quality standards of Alismatis Rhizoma and supply scientific evidence and recommendations for the quality control of Alismatis Rhizoma in Chinese Pharmacopoeia(Ch. P) 2020 edition. The contents of water, total ash, heavy metals and deleterious element, pesticide residues and alcohol-soluble extract were analyzed according to the methods listed in the volume Ⅳ of Ch. P 2015 edition. Alisol B 23-acetate, alisol C 23-acetate and reference herbs were used to identify Alismatis Rhizoma by TLC method, which was developed by using a mixture of dichloromethane-methanol(15∶1) as developing solvent on silica gel GF_(254 )precoated plates. In HPLC method, alisol B 23-acetate and alisol C 23-acetate were separated with acetonitrile-water as the mobile phase and detected at 208 nm and 246 nm, respectively. Thirty-seven batches of crude drugs, thirty batches of prepared slices and nineteen batches of salt prepared slices of Alismatis Rhizoma were determined according to the methods established. The quality standards established based on the research results were specific and repeatable, and suitable for the quality evaluation of Alismatis Rhizoma. We recommended that the botanical sources, TLC examination, alcohol-soluble extract of salt prepared slices and content determination should be revised in the Ch. P 2020 edition.

[Studies on quality standards of Poria]

In order to provide scientific recommendations for the revision of the quality standards of Poria in Chinese Pharmacopoeia(Ch. P) 2020 edition, a series of experiments were carried out to improve the quality standards of Poria. TLC methods were established to identify Poria by using pachymic acid, dehydrotumulosic acid and reference herbs as reference substances. The contents of water, total ash, pesticide residues, heavy metals and deleterious element, mycotoxins, sulfur dioxide residues and ethanol-soluble extract of herbal materials and decoction pieces of Poria were determined according to the methods recorded in the volume Ⅳ of Ch. P 2015 edition. An HPLC method was developed for the determination of pachymic acid and dehydropachymic acid. The contents of polysaccharide were determined by spectrophotometry using D-glucose as reference substance. The quality standards were established on the basis of the research results, in which the [assay] were added, and the [identification] and [tests] were revised when compared with Ch. P 2015 edition. The established methods are simple, specific, repeatable, and suitable for the quality evaluation of Poria.

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa

Background

The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa’s current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni.

Aim

This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards.

Setting

The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province.

Methods

A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted.

Results

The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards.

Conclusion

Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance.

From Isolation of Phosphate Solubilizing Microbes to Their Formulation and Use as Biofertilizers: Status and Needs

The production of biofertilizers at industrial level is a bottleneck because bacterial strains are generally developed and managed by research laboratories and not by production units. A seamless transition from laboratory to field application is, therefore necessary. This review provides an overview of the constraints that limiting the application or the implementation of Actinobacteria based biofertilizers especially in agricultural field and suggests solutions to overcome some of these limits. General processes of making and controlling the quality of the inoculum are briefly described. In addition, the paper underlines the opportunity of biofertilizers alone or in combination with chemical fertilizers. This review also, highlights the latest studies (until June 2019) and focuses on P-solubilization microorganisms mainly Actinobacteria. The biotechnology of these bacteria is a glimmer of hope for rock phosphate (RP) bioformulation. Since direct application of RP fertilizer is not always agronomically effective due to its sparse solubility.

Mammography Dose Survey Using International Quality Standards

Digital mammography is the current standard for breast cancer screening. The absence of any dosimetric data, the quality standards, and the fear of radiation detriment, sometimes, hampers the smooth introduction of this technology and the launch of breast cancer screening programmes. As the breast cancer screening programmes are in development in Morocco, quality standards have been set in this study, so that any new breast cancer screening service could get started with their first analysis. The purpose of this study was to report the first Moroccan breast dose and to test quality standards compared with European guidelines. A dosimetric study is conducted by calculating mean glandular dose (MGD) for patients' breasts and polymethyl methacrylate (PMMA) for each thickness from recorded radiographic factors and X-ray tube (output and half-value layer) measurements using Dance's model for a digital mammography system. This is carried out to determine the correlation between phantom and patient measurements. The mean MGD for patient data was 1.02 ± 0.5 mGy and the compressed breast thickness was 55 ± 14 mm. For compressed breast thickness range of 50-60 mm, the MGD was 0.94 ± 0.3 mGy and the dose calculated with PMMA phantom for the same range thickness was 1.33 mGy. The results of MGD as a function of PMMA thickness is lower than the achievable limit curve proposed in the European guidelines. The average doses, which depend on the technical parameters of the mammography equipment, are in line with values obtained in European guidelines. In addition, an investigation is needed throughout the Moroccan territory, in the sense of optimization of radiological practices and techniques in mammographic centres aligning with the international recommendations.

Quality and Authenticity Control of Functional Red Yeast Rice-A Review

Red yeast rice (RYR) is made by fermenting the rice with Monascus. It is commonly used in food colorants, dyeing, and wine making in China and its neighboring countries. Nowadays RYR has two forms on the market: common RYR is used for food products, the other form is functional RYR for medicine. However, some researchers reported that commercial lovastatin (structure is consistent with monacolin K) is illegally added to common RYR to meet drug quality standards, so as to imitate functional RYR and sell the imitation at a higher price. Based on current detection methods, it is impossible to accurately distinguish whether functional RYR is adulterated. Therefore, it is especially important to find a way to authenticate functional RYR. In the current review, the advances in history, applications, components (especially monacolins, monacolins detection methods), quality standards, authentication methods and perspectives for the future study of RYR are systematically reviewed.

Recommendations to facilitate managers' compliance with quality standards at primary health care clinics

Background

The Republic of South Africa (RSA) is shifting towards universal health coverage and a unified health system. This milestone can be achieved through the implementation of National Health Insurance (NHI). To employ NHI, health establishments in the country are compelled to comply with quality standards. The non-compliance with quality standards at primary health care (PHC) clinics within a district in Gauteng, which was verified by quality standards’ audit reports, prompted an intervention. No prior research aimed at facilitating managers’ compliance with quality standards has been conducted within the context under study. This research gap necessitated an exploration on how managers’ compliance to quality standards at PHC clinics within a district in Gauteng could best be facilitated.

Objectives

To describe recommendations to facilitate managers’ compliance with quality standards at PHC clinics within a district in Gauteng.

Method

A qualitative, exploratory, descriptive and contextual research design was used in this study. Semi-structured, individual interviews were conducted.

Results

The recommendations to facilitate managers’ compliance with quality standards at PHC clinics within a district in Gauteng were described. However, for the purpose of this article, only the recommendations seeking to address challenges with management practices as a reason for non-compliance with quality standards at PHC clinics will be discussed. These recommendations include involvement of PHC clinic managers in decision-making, adequate support from senior management and improvement of internal communication practices.

Conclusion

The researcher concludes that the senior management team in the district under study should strive to embrace the described recommendations as a strategy to facilitate managers’ compliance to quality standards at PHC clinics.

Developing quality criteria for patient-directed knowledge tools related to clinical practice guidelines. A development and consensus study

BACKGROUND

Patient-directed knowledge tools such as patient versions of guidelines and patient decision aids are increasingly developed to facilitate shared decision making. In this paper, we report how consensus was reached within the Netherlands on quality criteria for development, content and governance of these tools.

METHOD

A 12-month development and consensus study. The consortium worked on four work packages: (a) reviewing existing criteria; (b) drafting the quality criteria; (c) safe-guarding the acceptability and feasibility of the draft criteria by participatory research in on-going tool development projects; and (d) gaining formal support from national stakeholders on the quality criteria.

RESULTS

We reached consensus on a 8-step guidance; describing minimal quality criteria for (a) the team composition; (b) setting the scope; (c) identifying needs; (d) the content and format; (e) testing the draft; (f) finalizing and approval; (g) dissemination and application, and (h) ownership and revision. The participants of the on-going tool development projects were positive about the quality criteria in general, but divided as to the degree of detail. Whereas some expressed a clear desire for procedural standards, others felt that it would be sufficient to provide only general directions. Despite the different views as to the degree of detail, consensus was reached in three stakeholder meetings.

DISCUSSION

We successfully collaborated with all stakeholders and achieved formal support from national stakeholders on a set of minimum criteria for the development process, content and governance of patient-directed knowledge tools.

Overcoming Barriers to Growth in Home-Based Palliative Care

BACKGROUND

Home-based palliative care fills a critical gap between acute care (during crises) and hospice care for seriously ill patients. As of 2018, home-based palliative care capacity in the United States has not scaled to meet patient needs.

OBJECTIVES

The Center to Advance Palliative Care (CAPC) conducted a needs assessment to catalog and analyze barriers to growth in the field of home-based palliative care.

METHODS

Home-based palliative care program leaders were surveyed and interviewed to elicit information about program characteristics, barriers to meeting national palliative care quality standards or to program growth, and essential elements of program sustainability.

RESULTS

Home-based palliative care program leaders cited their major challenges as being: a lack of clarity on the applicability of national standards to home-based programs, a lack of sustainable financing methods for home-based palliative care, and lack of awareness of existing support resources for program design and leadership development.

CONCLUSIONS

Home-based palliative care programs will benefit from improved professional awareness of national quality standards and existing technical assistance. New prospects for alternative payment models that allow for sustainable interdisciplinary home-based care represent a promising opportunity for the field.

Multiplex and quantitative PCR targeting SCAR markers for strain-level detection and quantification of biofertilizers

Biofertilizers are the eco-friendly bio-input being used to sustain the agriculture by reducing the chemical inputs and improving the soil health. Quality is the major concern of biofertilizer technology which often leads to poor performance in the field and thereby loses the farmers' faith. To authenticate the strain as well as its presumed cell load of a commercial product, sequence characterized amplified region (SCAR) markers were developed for three biofertilizer strains viz., Azospirillum brasilense (Sp7), Bacillus megaterium (Pb1) and Azotobacter chroococcum (Ac1). We evaluated the feasibility of multiplex-PCR and quantitative real-time PCR for SCAR marker-based quality assessment of the product as well as the persistence of the strains during crop growth. We showed that multiplex PCR can concurrently discriminate the strains based on the amplicons' size and detects up to 10⁴ cells per g or per ml of carrier-based or liquid formulation of biofertilizer, respectively. The detection limit of quantitative PCR targeting SCAR markers is 10³  cells per g or ml of biofertilizer. Both the PCR methods detected and quantified them in the maize rhizosphere. Hence SCAR marker-based quality assessment would be a sensitive tool to monitor the biofertilizer production as well as its persistence in the inoculated crop rhizosphere.

Participatory capacity building for improving quality of childcare centers in Thailand

INTRODUCTION

Childcare centers (CCCs) with good quality standards can be effective in reducing the risk of diseases being easily spread from person to person. The aim of the present study's program, adapted from a method used by the United Nations Development Program, was to increase the capacity of local administrators(s) and heads of CCCs to improve quality standards.

METHODS

This study was quasi-experimental, with a one group pretest-post-test design. In this study the authors describe the effects and impacts of the program in Chonburi Province in eastern Thailand. Six LAs and 48 CCC heads were trained regarding (1) knowledge of the Thai Department of Health quality standards, (2) implementation and assurance and (3) program evaluation. The program consisted of three sequential participatory workshops. Effects at the center level were increased overall knowledge of quality standards of CCCs (QCCC), and developed skills of improvement plans. The impact at the center level was CCCs achieving the QCCC. At the child level it was the reduction in the period prevalence of three diseases and two symptoms.

RESULTS

The significant (p<0.05) effects and impacts at the center level were increased overall knowledge of QCCC in LAs and CCC heads and increased overall managerial skills of CCC heads. At the child level, the period prevalence of chickenpox and diarrhea symptom were reduced.

CONCLUSION

Participatory capacity building is an appropriate way to enhance the managerial skills of LAs and heads of CCCs for improving quality of CCCs to meet the local authority and the Ministry of Public Health quality standards.

[Physical fingerprint for quality control of Reduning injection]

The method of physical fingerprint spectrum for Reduning injection (RI) was proposed in this paper to improve its quality standards based on the strong correlation between physicochemical properties of drugs, their safety, effectiveness and stability. The quality of RI was studied by the thought and method of physical chemistry. The physical fingerprint spectrum was visually showed by the radar map, and consisted of eight indexes (pH, conductivity, turbidity, refractive index, osmolarity, surface tension, relative density, and kinematic viscosity). Then 12 batch of samples were verified. It was found that the physical fingerprint spectra of 3 batches of RI were in line with the standards within their validity time, with similarity above 0.999; in addition for the expired 9 batches of RI, their physical fingerprint spectra did not meet the standards. The results showed that physical fingerprint spectrum can be used for the quality control of RI, with a certain exemplary role in the quality evaluation of traditional Chinese medicine injection.

Quality assessment of palliative home care in Italy

RATIONALE

The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted.

AIMS AND OBJECTIVES

Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature.

METHODS

The evaluation strategy is based on Rasch analysis, allowing to objectively measuring both performances of facilities and quality indicators' difficulty on the same metric, using 14 quality indicators identified by the observatory's steering committee.

RESULTS

Globally, 195 home care teams were registered in the observatory reporting globally 40 955 cured patients in 2013 representing 66% of the population of home palliative care units active in Italy in 2013. Rasch analysis identifies 5 indicators ("interview" with caregivers, continuous training provided to medical and nursing staff, provision of specialized multidisciplinary interventions, psychological support to the patient and family, and drug supply at home) easy to endorse by health care providers and 3 problematic indicators (presence of a formally established Local Network of Palliative care in the area of reference, provision of the care for most problematic patient requiring high intensity of the care, and the percentage of cancer patient dying at Home).

CONCLUSIONS

The lack of Local Network of Palliative care, required by law 38/2010, is, at the present, the main barrier to its application. However, the adopted methodology suggests that a clear roadmap for health facilities to afford future quality and normative challenges.

Dilemma of nitrogen management for future food security in sub-Saharan Africa - a review

Food security entails having sufficient, safe, and nutritious food to meet dietary needs. The need to optimise nitrogen (N) use for nutrition security while minimising environmental risks in sub-Saharan Africa (SSA) is overdue. Challenges related to managing N use in SSA can be associated with both insufficient use and excessive loss, and thus the continent must address the 'too little' and 'too much' paradox. Too little N is used in food production (80% of countries have N deficiencies), which has led to chronic food insecurity and malnutrition. Conversely, too much N load in water bodies due mainly to soil erosion, leaching, limited N recovery from wastewater, and atmospheric deposition contributes to eutrophication (152 Gg N year-1 in Lake Victoria, East Africa). Limited research has been conducted to improve N use for food production and adoption remains low, mainly because farming is generally practiced by resource-poor smallholder farmers. In addition, little has been done to effectively address the 'too much' issues, as a consequence of limited research capacity. This research gap must be addressed, and supportive policies operationalised, to maximise N benefits, while also minimising pollution. Innovation platforms involving key stakeholders are required to address N use efficiency along the food supply chain in SSA, as well as other world regions with similar challenges.

Defining criteria for good environmental journalism and testing their applicability: An environmental news review as a first step to more evidence based environmental science reporting

While the quality of environmental science journalism has been the subject of much debate, a widely accepted benchmark to assess the quality of coverage of environmental topics is missing so far. Therefore, we have developed a set of defined criteria of environmental reporting. This instrument and its applicability are tested in a newly established monitoring project for the assessment of pieces on environmental issues, which refer to scientific sources and therefore can be regarded as a special field of science journalism. The quality is assessed in a kind of journalistic peer review. We describe the systematic development of criteria, which might also be a model procedure for other fields of science reporting. Furthermore, we present results from the monitoring of 50 environmental reports in German media. According to these preliminary data, the lack of context and the deficient elucidation of the evidence pose major problems in environmental reporting.

Popular apps on the medical category targeting patients and the general public in the United Kingdom: Do they conform to the Health On the Net Foundation principles?

Smartphones with their rising popularity and versatile software 'apps' have great potential for revolutionising healthcare services. However, this was soon overshadowed by concerns highlighted by many studies over quality. These were subject and/or discipline specific and mostly evaluated compliance with a limited number of information portrayal standards originally devised for health websites. Hence, this study aimed to take a broader approach by evaluating the most popular apps categorised as medical in the United Kingdom for compliance with all of those standards systematically using the Health On the Net (HON) Foundation principles. The study evaluated top 50 free and paid apps of the 'medical' category on both iTunes and Google stores for evidence of compliance with an app-adapted version of the HON Foundation code of conduct. The sample included 64 apps, 34/64 (53%) were on Google Play and 36/64 (56%) were free. None of the apps managed to comply with the entire eight principles. Compliance with seven principles was achieved by only one app (1.6%), and the rest were compliant with three, two, and one (14.7%, 27%, and 38%, respectively). In conclusion, this study demonstrated that most popular apps on the medical category that are available in the United Kingdom do not meet the standards for presenting health information to the public, and this is consistent with earlier studies. Improving the situation would require raising the public awareness, providing tools that would assist in quality evaluation, encouraging developers to use robust development process, and facilitating collaboration and engagement among the stakeholders.

Quality standards for Hutabhugādi cūrṇa (Ayurvedic Formulary of India)

In India, herbal medicines are mainly based on the Ayurvedic system. The main drawback of traditional medicines is a lack of standardized products. Standardization of any herbal formulation is essential in order to assess the quality, purity, safety, and efficacy of drugs based on the analysis of their active properties. Testing of Ayurvedic preparations using scientific methodologies will add to quality and authenticity of the product. This article reports standardization parameters for Hutabhugādi cūrṇa (HC) used traditionally in the treatment of Agnimāndya (digestive impairment), Pāndu (anemia), Sopha (edema), and Ārsa (piles). The formulation was prepared as per Ayurvedic Formulary of India, and it was standardized by organoleptic characterization, macro–microscopic evaluation, physicochemical testing, and thin-layer chromatography/high-performance thin-layer chromatography profiling employing a standard methodology. Results of the experiments conducted provided diagnostic characteristics to identify and standardize the formulation prepared using official ingredients of HC. Based on the data obtained, a monograph on quality standards for HC is proposed. The monograph based on the present investigation results would serve as a document to control the quality of HC.

Quality standards for bone conduction implants

CONCLUSION

Bone conduction implants are useful in patients with conductive and mixed hearing loss for whom conventional surgery or hearing aids are no longer an option. They may also be used in patients affected by single-sided deafness.

OBJECTIVES

To establish a consensus on the quality standards required for centers willing to create a bone conduction implant program.

METHOD

To ensure a consistently high level of service and to provide patients with the best possible solution the members of the HEARRING network have established a set of quality standards for bone conduction implants. These standards constitute a realistic minimum attainable by all implant clinics and should be employed alongside current best practice guidelines.

RESULTS

Fifteen items are thoroughly analyzed. They include team structure, accommodation and clinical facilities, selection criteria, evaluation process, complete preoperative and surgical information, postoperative fitting and assessment, follow-up, device failure, clinical management, transfer of care and patient complaints.

Automated Detection of HONcode Website Conformity Compared to Manual Detection: An Evaluation

Background

To earn HONcode certification, a website must conform to the 8 principles of the HONcode of Conduct In the current manual process of certification, a HONcode expert assesses the candidate website using precise guidelines for each principle. In the scope of the European project KHRESMOI, the Health on the Net (HON) Foundation has developed an automated system to assist in detecting a website’s HONcode conformity. Automated assistance in conducting HONcode reviews can expedite the current time-consuming tasks of HONcode certification and ongoing surveillance. Additionally, an automated tool used as a plugin to a general search engine might help to detect health websites that respect HONcode principles but have not yet been certified.

Objective

The goal of this study was to determine whether the automated system is capable of performing as good as human experts for the task of identifying HONcode principles on health websites.

Methods

Using manual evaluation by HONcode senior experts as a baseline, this study compared the capability of the automated HONcode detection system to that of the HONcode senior experts. A set of 27 health-related websites were manually assessed for compliance to each of the 8 HONcode principles by senior HONcode experts. The same set of websites were processed by the automated system for HONcode compliance detection based on supervised machine learning. The results obtained by these two methods were then compared.

Results

For the privacy criterion, the automated system obtained the same results as the human expert for 17 of 27 sites (14 true positives and 3 true negatives) without noise (0 false positives). The remaining 10 false negative instances for the privacy criterion represented tolerable behavior because it is important that all automatically detected principle conformities are accurate (ie, specificity [100%] is preferred over sensitivity [58%] for the privacy criterion). In addition, the automated system had precision of at least 75%, with a recall of more than 50% for contact details (100% precision, 69% recall), authority (85% precision, 52% recall), and reference (75% precision, 56% recall). The results also revealed issues for some criteria such as date. Changing the “document” definition (ie, using the sentence instead of whole document as a unit of classification) within the automated system resolved some but not all of them.

Conclusions

Study results indicate concordance between automated and expert manual compliance detection for authority, privacy, reference, and contact details. Results also indicate that using the same general parameters for automated detection of each criterion produces suboptimal results. Future work to configure optimal system parameters for each HONcode principle would improve results. The potential utility of integrating automated detection of HONcode conformity into future search engines is also discussed.

Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care

OBJECTIVE

To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics.

DATA SOURCES

Nurse survey and VLBW infant registry data.

STUDY DESIGN

Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk.

DATA COLLECTION

Primary nurse survey (N = 5,773, 77 percent response rate).

PRINCIPAL FINDINGS

VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities.

CONCLUSIONS

Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.

Qualitative and quantitative assessment of four marketed formulations of brahmi

This study was conducted with the aim to compare two batches each of four popular commercial formulations of Bacopa monnieri (Brahmi), and report, if any, inter-batch variations. The formulations were procured from local market and analyzed for label specifications, uniformity of weight of capsule, identity, purity and strength parameters (total ash content test, acid insoluble ash content, water soluble extractive, alcohol soluble extractive, loss on drying). Bacoside A, one of the pharmacologically active saponin present in B. monnieri, was quantified in all the formulations using UV-spectrophotometer. In addition each formulation was assessed and compared for variation in biological activity using in vitro test for hemolytic activity using human erythrocytes. The results of the study show that there is a wide variation in the quality and content of herbal drugs marketed by different manufacturers. More importantly this study demonstrates that there exists a bigger challenge of batch-to-batch variation in the quality and content of herbal formulations of the same manufacturer. This challenge of providing standardized formulations is being faced by not any one manufacturing house but by all, and may be attributed firstly to, lack of stringent regulations and secondly to high variability in raw material quality.

Quality assurance: Importance of systems and standard operating procedures

It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company.

DxS Ltd

DxS is a personalized medicine company focused on providing genetic analysis services and technologies to enable the delivery of safe and effective medicines. The services provide support for drug development, diagnostic product development and pharmacodiagnostics. There is an increasing demand from the pharmaceutical industry for genetic analysis of clinical trial populations to help to understand individual variation in drug pharmacokinetics and pharmacodynamics. Since these studies are part of a clinical trial it is essential that they are performed in a high quality environment that meets relevant regulatory standards. DxS operates a genotyping service operation that fulfils all of these requirements. One of the expectations deriving from the growing use of pharmacogenetics during clinical development is that some of the genetic markers will be required as diagnostics to allow the identification of suitable patients for a therapy. This combination of a drug and a diagnostic is called personalized medicine. DxS have established a global network of alliance laboratories to allow the rapid translation of tests from clinical development into clinical diagnostics.

[Surgical experience with conventional pacemaker leads]

Background and objectives Due to the nonexistence of clear-cut recommendations for pacemaker lead selection, it was the objective of this retrospective observational study to define the clinical status of conventional leads. For this purpose, we compared our results with two conventional leads to modern and more expensive lead designs such as steroid-eluting and/or high impedance leads in the literature. Patients and methods Intra- and postoperative data of 231 patients who underwent implantation of 178 unipolar, carbon-coated atrial screw-in leads and 231 unipolar, tined leads with a sintered platinum lead tip in the ventricle between 1 Jan 1996 and 31 Dec 2000 were reviewed. Results Intraoperatively, we measured pacing thresholds of 0.87±0.35 V (range: 0.1-2.0V) in the atrium and 0.31±0.13 V (range: 0.1-1.1V) in the ventricle. P-wave amplitude was 3.3±1.5mV (range: 1.0-12.6mV) and R-wave amplitude 13.6±5.1mV (range: 4.2-25.0mV). Postoperatively, we found a chronic pacing threshold of ≤1.2V/1.0ms and 2.5V/0.2ms, respectively, in 97 out of 123 atrial (79%) and 136 out of 161 ventricular leads (85%) (n.s.). Chronic detection threshold measured 3.4±1.3mV in the atrium and 9.2±2.4 mV in the ventricle. Four out of 409 leads (1%) had to be reoperated due to diaphragmatic stimulation (n=1) and loss of capture (n=3). Conclusions 1) Conventional pacemaker leads show good results in the majority of cases. 2) However, modern lead concepts are reported to provide lower pacing thresholds as well as a lower current drain due to pacing. 3) Therefore, the implantation of these leads could be advantageous in younger patients and patients undergoing reoperation because of pacing threshold problems. 4) However, this requires in addition the usage of pulse generators with low internal current drain and optimized postoperative programming of output parameters. 5) Lead-related complication rates as well as the incidence of other perioperative problems should be reason enough to develop standards for pacemaker implantation.